Active NPI
Convenientmd LLC
- Urgent Care Clinic/Center
- Bangor, ME
National Provider Identifier
1992281422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urgent Care Clinic/Center
- Legal business name
- CONVENIENTMD LLC
- Practice address
- 543 Broadway
Bangor, ME 04401-3337 - Phone
- (207) 922-1300
- NPI assigned
- Jul 18, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gareth Dickens
- Title
- Co-Ceo
- Phone
- (603) 501-0863
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | Primary |
Addresses
Primary practice location
543 Broadway
Bangor, ME 04401-3337
Mailing address
111 New Hampshire Ave
Portsmouth, NH 03801-2864
Phone (603) 410-6700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180220000535 | ME | Part B Supplier - Clinic/Group Practice | 2062667033 |
Receives reassigned benefits from 9 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ellsworth, ME; Saco, ME; Sanford, ME; Westbrook, ME; Portland, ME; Bangor, ME; Augusta, ME; Auburn, ME… |
Other NPIs on the same Medicare enrollment 12
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Bangor, ME
- NPI 1083913735
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531872000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1531872000000",
"number": "1992281422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 NEW HAMPSHIRE AVE",
"city": "PORTSMOUTH",
"state": "NH",
"postal_code": "038012864",
"telephone_number": "603-410-6700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "543 BROADWAY",
"city": "BANGOR",
"state": "ME",
"postal_code": "044013337",
"telephone_number": "207-922-1300"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CONVENIENTMD LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-07-18",
"last_updated": "2018-07-18",
"status": "A",
"authorized_official_last_name": "DICKENS",
"authorized_official_first_name": "GARETH",
"authorized_official_title_or_position": "CO-CEO",
"authorized_official_telephone_number": "603-501-0863"
},
"taxonomies": [
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.